Effects of High-frequency Oscillatory Ventilation on Systemic and Cerebral Hemodynamics and Tissue Oxygenation: An Experimental Study in Pigs
- 306 Downloads
In this study, we compare the effects of high frequency oscillatory ventilation (HFOV) with those of lung-protective volume-controlled ventilation (VCV) on cerebral perfusion, tissue oxygenation, and cardiac function with and without acute intracranial hypertension (AICH).
Eight pigs with healthy lungs were studied during VCV with low tidal volume (VT: 6 ml kg−1) at four PEEP levels (5, 10, 15, 20 cmH2O) followed by HFOV at corresponding transpulmonary pressures, first with normal ICP and then with AICH.
Systemic and pulmonary hemodynamics, cardiac function, cerebral perfusion pressure (CPP), cerebral blood flow (CBF), cerebral tissue oxygenation, and blood gases were measured after 10 min at each level. Transpulmonary pressures (TPP) were calculated at each PEEP level. The measurements were repeated with HFOV using continuous distending pressures (CDP) set at TPP plus 5 cmH2O for the corresponding PEEP level. Both measurement series were repeated after intracranial pressure (ICP) had been raised to 30–40 cmH2O with an intracranial balloon catheter.
Cardiac output, stroke volume, MAP, CPP, and CBF were significantly higher during HFOV at normal ICP. Systemic and cerebral hemodynamics was significantly altered by AICH, but there were no differences attributable to the ventilatory mode.
HFOV is associated with less hemodynamic compromise than VCV, even when using small tidal volumes and low mean airway pressures. It does not impair cerebral perfusion or tissue oxygenation in animals with AICH, and could, therefore, be a useful ventilatory strategy to prevent lung failure in patients with traumatic brain injury.
KeywordsVolume controlled ventilation HFOV Cerebral blood flow Cerebral tissue oxygenation Hemodynamics
- 19.Rohde V, Rohde I, Thiex R, et al. Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. J Neurosurg. 2002;97:954–62.PubMedCrossRefGoogle Scholar
- 24.Hall SR, Wang L, Milne B, Hong M. Left ventricular dysfunction after acute intracranial hypertension is associated with increased hydroxyl free radical production, cardiac ryanodine hyperphosphorylation, and troponin I degradation. J Heart Lung Transplant. 2005;24:1639–49.PubMedCrossRefGoogle Scholar
- 29.Wiesenack C, Prasser C, Keyl C, Rodig G. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anesth. 2001;15:584–8.PubMedCrossRefGoogle Scholar